Problems with surveillance methods for alcoholism: differences in coding systems among federal, state, and private agencies

Are minority children under- or overrepresented in pediatric research?

OBJECTIVES

There is extensive documentation that minority adults are underrepresented in medical research, but there are scant data regarding minority children and their parents.

METHODS

All full-length articles published in the paper edition of 3 general pediatric journals between July 1999 and June 2000 were collected and reviewed. Articles were excluded when they did not include at least 1 US researcher, all subjects at US institutions, parents or children as subjects, some prospective data collection, or between 8 and 10 000 subjects. We recorded the number and race/ethnicity (R/E) of all subjects, the type of research, and the type of data collected. Corresponding authors were surveyed to clarify R/E data.

RESULTS

A total of 192 studies qualified. R/E data were reported in 114 (59%) studies, and survey data provided additional or new information in 25 studies resulting in R/E data in 128 (67%) articles accounting for 75% of the subjects. R/E was described by >10 different labels. There was an overrepresentation of black subjects and an underrepresentation of white and Hispanic subjects compared with the census data. When compared with research participation of child subjects, generally, black children were overrepresented and Hispanic children were underrepresented in clinical trials, and both were underrepresented in therapeutic research. Black and Hispanic children were overrepresented in potentially stigmatizing research.

CONCLUSIONS

Overall, we found an overrepresentation of black subjects and an underrepresentation of white and Hispanic subjects with significant variations depending on the type of research.

AIDS surveillance among American Indians and Alaska natives

To assess the human immunodeficiency virus epidemic among American Indians and Alaska Natives (AI/AN), we examined acquired immunodeficiency syndrome (AIDS) case and seroprevalence data through December 1990. While AI/AN had a low 1990 reported AIDS case rate (4.0/100,000), the increase in diagnosed cases adjusted for reporting delays from 1989 to 1990 was higher (23.1%) among AI/AN than any other racial/ethnic group. Seroprevalence data for military applicants have documented higher rates for AI/AN than for either Whites or Asian/Pacific Islanders.

The Nursing Minimum Data Set: abstraction tool for standardized, comparable, essential data

The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These minimum core data, used on a regular basis by the majority of nurses in the delivery of care across settings, can provide an accurate description of nursing diagnoses, nursing care, and nursing resources used. Collected on an ongoing basis, a standardized nursing data base will enable nurses to compare data across populations, settings, geographic areas, and time. Public health nurses will be able to evaluate and compare services. The purpose of this article is to discuss briefly the following aspects of the NMDS: background including definition, purposes, and elements; availability and reliability of the data; benefits; implications of the NMDS with emphasis on nursing research; and health policy decision making.

Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history

STUDY OBJECTIVE

The aim was to compare four different measures of women's social class (interview and census based) as predictors of well known social gradients in reproductive outcomes. The intent was to address two obstacles that confront research in the United States regarding social gradients in women's health: how women's social class should be measured, and the absence of socioeconomic data in most health records.

STUDY DESIGN

The study was a retrospective cohort analysis, using a community based random sample. Setting--Alameda County, California, 1987.

SUBJECTS

51 black and 50 white women, ages 20 to 80 years, identified by random digit dialling, were interviewed by telephone.

MEASUREMENTS AND MAIN RESULTS

Census data were linked to individual records via the respondents' addresses. Using number of full term pregnancies as an example, multiple linear regression analyses demonstrated that individual class was not significantly associated with this outcome, whereas household class was: women from non-working-class households had 0.8 fewer such pregnancies than women from working class households (95% confidence interval [CI] = -1.4, -0.1). The block group measure functioned most like the household class measure (beta = -0.7, 95% CI = -1.4, 0.1), while the census tract measure was non-significant (beta = -0.4, 95% CI = -1.2, 0.4). Similar results were obtained for the outcomes: age at first full term pregnancy, percent of early terminated pregnancies, and yearly income.

CONCLUSIONS

These results suggest block group data may offer a uniform source of social class information that can be appended to individual health records, and that this strategy is not invalidated by concerns regarding ecological fallacy.

Methodological issues in the epidemiological study of alcohol-drug problems: sources of confusion and misunderstanding

Epidemiological research on psychoactive substance use disorders can and sometimes does lead to conclusions that are mutually conflicting. A current example is the apparent drop in substance use among adolescents in schools, with continuing high levels of substance-associated adolescent suicide, hospitalization, and crime. In an effort to clarify such differences, the author underscores the importance of understanding the three most common epidemiological methods. Each has different histories, advantages, liabilities, inherent value sets, and disparate-but-overlapping purposes.

Latino/"Hispanic"--who needs a name? The case against a standardized terminology

Public health specialists, policy makers, social scientists, and politicians, for different reasons, have welcomed the "Hispanic" label. The label presumably identifies an ethnic group that is also a minority group (i.e., a group historically subject to economic exploitation and racial discrimination). Consequently, its consistent use by federal and state agencies would produce large quantities of comparable data useful for research, and for policy making and implementation. Critics have argued that the label is racist, it mystifies the real reasons for the disproportionately high proportion of people of Mexican and Puerto Rican descent in disadvantaged social and economic conditions, and stands in the way of a fair implementation of affirmative action. Latino, a race-neutral term with historical roots, has been suggested as an alternative to be used in conjunction with national origin or regional forms of self-identification. In this article, I argue that any standardized terminology is unavoidably flawed and conducive to the development of racist or, at best, trivial stereotypical analysis of the data thus produced. The "Hispanic" label does not identify an ethnic group or a minority group, but a heterogeneous population whose characteristics and behavior cannot be understood without necessarily falling into stereotyping. The label should be abandoned; social scientists and policy makers should, instead, acknowledge the existence of six aggregates, qualitatively different in their socioeconomic stratification, needs, and form of integration in the U.S. economy: two minority groups (people of Mexican and Puerto Rican descent), and four immigrant populations (Cubans, Central American refugees, Central American immigrants, and South American immigrants).

Sexually transmitted diseases and native Americans: trends in reported gonorrhea and syphilis morbidity, 1984-88

Native Americans experienced higher reported gonorrhea and syphilis morbidity than did non-Native Americans from 1984 through 1988 in 13 States with large Native American populations. Gonorrhea rates among American Indians and Alaska Natives were approximately twice the rates for non-Indians. The highest gonorrhea rate was reported among Alaska Natives, with a 5-year average of 1,470 cases per 100,000, more than five times the average non-Native rate in Alaska. The average primary and secondary (P&S) syphilis rate from 1984 through 1988 was more than two times higher among Native Americans, largely due to high syphilis morbidity in Arizona and New Mexico. In Arizona the average American Indian P&S syphilis case rate was seven times higher than the non-Indian rate. True rates for sexually transmitted diseases (STD) among Native Americans may be higher than those reported due to racial misclassification of Native American cases, particularly in nonreservation areas. Improved recognition and reporting of STD cases among Native Americans are needed to target STD prevention and education more effectively.